1. Managing lymphoedema
There are various treatments and techniques to manage lymphoedema.
The sooner you’re assessed and treated for lymphoedema, the easier it is to control.
In many cases the breast care nurse at your hospital will be able to help with mild lymphoedema.
If you’ve had swelling for some time, it’s severe or you have other symptoms, your GP may need to refer you to a specialist lymphoedema therapist, who will assess your swelling and discuss the best way to manage your symptoms. At first you’ll need regular guidance from your lymphoedema specialist to help manage your lymphoedema.
Keeping your skin in good condition is important to reduce the risk of infection.
People with lymphoedema have an increased risk of infection. If an infection develops it can lead to further damage to the lymphatic system and may make lymphoedema worse.
You can read skincare tips on our lymphoedema page.
You can also find detailed skincare tips in our booklet Living with lymphoedema after breast cancer.
3. Arm and shoulder exercises
Exercise during and after treatment
Your lymphoedema specialist, breast care nurse or physiotherapist may give you some specific shoulder, arm and hand exercises to encourage movement and help improve lymph drainage.
You can exercise your arm a little when you’re walking around by slowly bending and straightening it at the elbow. To relieve pressure and swelling in the hand, try slowly opening and closing it as if squeezing a rubber ball. Avoid letting your arm hang down for long periods as this can encourage the lymph fluid to collect.
You can also try our arm and shoulder exercises for lymphoedema.
If you’ve been fitted with a compression garment, wear this when doing any exercises to get the best results.
4. Staying active
Physical activity is a good way of managing swelling because moving the muscles encourages lymph fluid to move away from the swollen area.
Some people find activities such as running, swimming, cycling, Nordic walking, yoga and even dragon boat racing helpful.
If you want to increase your activity levels or take up a new activity, do it gradually and stop if you have any discomfort or notice further swelling.
If you use gym equipment, talk to an instructor and start with light weights until you’ve built up enough strength to use heavier ones without discomfort or increased swelling.
If you’ve been fitted with a lymphoedema garment, always wear it when you’re exercising or when you’re very active. You don’t need to wear compression garments while swimming. Wash your skin after swimming to get rid of chemicals from the pool or salt from the sea.
5. Maintaining a healthy weight
Being overweight can affect how much your arm swells and how you respond to treatment for lymphoedema.
To maintain a healthy weight, follow a healthy, well-balanced diet and do some regular physical activity.
If you’re concerned about your weight, your lymphoedema specialist, GP or pharmacist may be able to advise you on losing weight or refer you to a dietitian. The NHS website has lots of tips on losing weight.
6. Compression garments
Compression garments are designed to reduce swelling and prevent further swelling by encouraging lymph fluid to drain away from the affected arm.
If the swelling is in your arm or hand you may be fitted with a compression sleeve or glove.
You may be prescribed a compression bra or vest, which is similar to a sports bra.
Putting the garment on
You should be shown how to apply the garment properly.
It’s sometimes difficult to apply compression sleeves, and you should be offered an applicator.
When using a compression garment:
- Apply and remove the garment carefully
- Put it on in the morning when there’s usually less swelling
- Make sure there are no wrinkles and that the fabric is evenly spread
- Never turn the top of the garment over if it seems too long as this will put too much pressure on one area
When to wear it
Wear your compression garment during the day to help keep your swelling under control.
If it feels too much to wear the garment all day at first, start by wearing it for a few hours each day. Then gradually increase the time so that you’re eventually wearing it all day.
The compression garment is most useful when your muscles are working actively and least useful during rest.
Many lymphoedema specialists suggest wearing compression garments when flying.
Problems to look out for
Contact your lymphoedema specialist or breast care nurse if:
- You develop an infection in your arm or breast
- You have concerns about how your garment fits
- You find it painful to wear your garment
- You notice a change in sensation such as numbness or tingling in your arm or hand, or a change in colour at the tips of your fingers
- Your skin feels sore or itchy
Replacing your garment
After wearing a compression garment for about six months, the fit and support will need to be checked.
Contact your lymphoedema specialist, breast care nurse or GP before getting your next new garment.
7. Compression bandages
Compression bandages are used if:
- The swelling has made the limb a difficult size or shape for compression garments to be fitted
- The skin has become damaged and sore, when using compression garments may cause more damage
Several layers of bandages are put on the arm and hand by a lymphoedema specialist or another trained healthcare professional. At first these can make the arm seem bigger than normal and they may feel bulky.
The bandages may be removed and reapplied regularly, depending on the severity of the swelling.
Over two to four weeks of regular bandaging, the arm shape will change and the swelling will reduce so compression garments can be fitted to control the remaining swelling.
It’s important to exercise and move your arm around as much as possible while the bandages are in place, as this will improve their effectiveness.
Compression wraps are foam tubes with Velcro fastening which can be used as an alternative to bandaging. They’re available for both the arm and hand.
8. Manual lymphatic drainage (MLD)
Manual lymphatic drainage (MLD) is a specialised type of massage carried out by a trained practitioner.
The MLD therapist uses hand movements to stimulate lymph drainage and move lymph fluid away from areas where it has collected. It’s a slow, very light rhythmical treatment that takes time to complete.
MLD is usually combined with other compression treatments to achieve a better result. It can be particularly useful over areas where compression garments cannot easily be worn, such as the chest area.
Your lymphoedema specialist can tell you if MLD may help you.
This treatment is available in some NHS hospitals, Macmillan centres or privately. If you use a private therapist, check they’re registered with the British Lymphology Society.
9. Simple lymphatic drainage (SLD)
Your lymphoedema specialist may teach you a simple type of skin massage called simple lymphatic drainage (SLD). It’s based on the principles of MLD.
If you’ve been taught SLD, you’ll be advised to do it one or more times a day depending on your condition. You need to do SLD carefully and not change the sequence of the movements because this will affect how well it works.
If you find it difficult to do the skin massage yourself, someone else can be taught how to help you with it.
The technique is best done without using oils or cream on the skin so that good contact is kept between the hand and the skin.
10. Kinesio Taping
Kinesio Taping is suitable for some people with lymphoedema. It uses a type of adhesive tape applied to the skin by a trained therapist. You can be shown by your specialist how to replace the tape.
The tape lifts the skin during movement and encourages lymph fluid to move towards other areas and the .
Kinesio Tape is usually used with other forms of treatment. But it’s sometimes used on its own to manage lymphoedema if it develops in areas such as the breast and chest wall. It can also be used to soften and reduce hard, firm tissue (fibrosis).
11. Other treatments for lymphoedema
The following treatments are sometimes used alongside the ones already described to manage lymphoedema, but their benefits are less clear.
Research is being carried out into using surgery to treat lymphoedema, and it may be considered for some people. However, it’s not yet widely available and results vary.
Microsurgery (lymphatic reconstruction)
Microsurgery (lymphatic reconstruction) for lymphoedema is a relatively new procedure. It’s performed under local anaesthetic by plastic surgeons with special training in microsurgery. It aims to make new routes by joining lymph and blood vessels, to help the lymphatic system transport more lymph fluid.
Lymph node transfer
Lymph node transfer involves removing healthy lymph nodes from one part of the body and transferring them to the armpit area.
This is a surgical procedure in which fat is removed from the affected area. It’s not standard treatment for lymphoedema in the UK. It should not be considered before other therapies such as exercise, compression bandaging and MLD have been tried and had maximum benefit.
People who have this procedure are advised to wear a life-long compression garment, 24 hours a day to keep the swelling down.
Mechanical compression pumps mimic the effect of MLD by squeezing the swollen arm in a plastic sleeve, which inflates and deflates at regular intervals. Pumps are usually used alongside other therapies.
They should never be used without the advice and close supervision of your lymphoedema therapist.
Low-level laser therapy
This treatment uses a low-energy laser to improve the flow of lymph fluid. Research is ongoing but some studies suggest it may be helpful for reducing the amount of swelling, firmness (fibrosis) and discomfort.
12. Emotional effects
For some people, learning to live with lymphoedema can be harder than coming to terms with the cancer itself.
Please don’t be afraid to ask for help from your lymphoedema specialist or breast care nurse. You can also call our helpline - please see below.
We can put you in touch with a trained volunteer who has lymphoedema through our Someone Like Me service - also below.
You can also chat to other people living with lymphoedema on our forum.
And you can find more information and support from: